Osteoporosis drug initiation may lower mortality risk in adults with epilepsy
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Adults with epilepsy who initiated any osteoporosis drug therapy had a lower 3-year mortality risk compared with those who did not take a medication, according to study data published in Bone.
“The primary finding from this study suggests that osteoporosis medication is associated with a 30% reduced 3-year mortality risk among adults with epilepsy, with the effect noticeable by 6 months, which was the earliest time point to track mortality in the current study,” Daniel G. Whitney, PhD, assistant professor in the department of physical medicine and rehabilitation at the University of Michigan, wrote in a study published in Bone. “Although the 3-year mortality risk was elevated for adults with vs. without epilepsy that initiated osteoporosis medication by approximately 42% to 49%, a qualitative assessment may suggest that the difference in mortality risk starts to become apparent at approximately 1.3 years after starting osteoporosis medication. This time course assessment may point towards potential windows of opportunity for additional and/or revised interventions to further reduce mortality risk.”
Whitney conducted a retrospective observational cohort study using claims data from the Optum Clinformatics Data Mart Database. Baseline data were collected from 2012 to September 2014, and mortality data were collected through September 2017. Data were extracted for adults aged 50 years or older who had 12 months of continuous enrollment through the start of follow-up, had 6 months of continuous enrollment and were alive after the start date of follow-up, and used health care services for at least 2 days during the baseline period. Participants were considered to have epilepsy if they had at least one reimbursement claim for epilepsy and recurrent seizures on 2 or more separate days within a 12-month period. Osteoporosis medications were identified through the first outpatient pharmacy claim between 2013 and September 2014. Follow-up for osteoporosis medication users began at the date of their first claim for a medication. Adults who did not use osteoporosis medication were randomly assigned a follow-up start date between 2013 and September 2014.
There were 733 adults with epilepsy who were new users of osteoporosis medication included in the analysis. The cohort was compared with a group of 2,932 adults with epilepsy who did not use osteoporosis medication, and another group of 2,932 adults without epilepsy who were new osteoporosis medication users. During follow-up, 7.2% of those with epilepsy using osteoporosis medication died, 10% died from the nonusers group and 5.2% of adults without epilepsy who used medication died.
Adults with epilepsy who were new users of osteoporosis medication had a lower incidence rate ratio (IRR) of mortality compared with those who had epilepsy and did not use medication (IRR = 0.69; 95% CI, 0.52-0.93). Those with epilepsy who used osteoporosis medication had a higher mortality rate compared with adults who did not have epilepsy (IRR = 1.42; 95% CI, 1.04-1.94). The results were similar when the groups were broken down by sex and after adjusting for covariates.
Before adjusting for covariates, participants with epilepsy who used bisphosphonates had a lower mortality risk compared with those who used other medications (HR = 0.45; 95% CI, 0.25-0.8). After adjusting for covariates, the association was not significant.
“While there was evidence that treatment with bisphosphonates was associated with a lower mortality risk only among adults with epilepsy in the exploratory analysis, future studies are needed to confirm this finding and perform a more comprehensive comparative analysis with other osteoporosis medications,” Whitney wrote.
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